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New Hampshire Medicaid History and Facts

Initial Medicaid Implementation: New Hampshire began their Medicaid program in July of 1967. The state had run programs that helped people with limited incomes since the 1930s, prior to the implementation of the Social Security Act. The state had some issues with determining the correct payment rates and ensuring that there was little fraudulent payments, like many other states were experiencing at the time.

Key Medicaid Political Issues: New Hampshire, like other states in New England, has a low rate of uninsurance. New Hampshire extends CHIP coverage up to 300% of the poverty level, making it one of the most generous programs in terms of extending coverage to higher income families. The eligibility in these programs is divided into several levels of income eligibility and generosity of benefits. New Hampshire has a system that allows counties to contribute toward the cost of nursing facility services. New Hampshire has historically had high per-beneficiary spending, particularly for the aged, blind, and people with disabilities. Of that, the dual eligible population has driven a majority of those costs. After an attempt by the governor’s office to implement a waiver program that would move payments out of nursing facilities and into the home the legislature began requiring Medicaid waivers be approved by the legislature before submission. In recent years the focus of the Medicaid program has been on addressing the treatment of people with opioid dependency as the state has been on the forefront of the opioid epidemic.

Medicaid Expansion Implementation: New Hampshire passed their Medicaid expansion in March of 2014. The state legislation required the governor to expand Medicaid using an 1115 waiver but allowed the state to expand through a state plan amendment while the 1115 waiver was being approved. This meant that enrollment for Medicaid expansion began in August of 2014 but the 1115 waiver was approved in November of 2014. Meaning that for a few months people enrolled in coverage without the stipulations of the waiver. The state governor flipped to being controlled by a Republican governor in 2016. In 2018 the state became the fourth state to have a work requirement plan approved by CMS. The plan is set to be implemented in January of 2019.